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Lifelong doubling of mortality in men entering adult life as obese

International Journal of Obesity volume 35, pages 1193–1199 (2011)Cite this article

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Abstract

Background:

The association between obesity in adults and excess morbidity and mortality is well established, but the impact of being obese in early adulthood on health throughout adult life needs elucidation. We investigated the all-cause mortality until 80 years of age in men starting adult life as obese.

Methods:

Among 362 200 Danish young men, examined for military service between 1943 and 1977, all obese (defined as body mass index (BMI)⩾31.0 kg m−2), and, as controls, a random 1% sample of the remaining population were identified. A total of 1862 obese, corresponding to all men above the 99.5 percentile in this population, and 3476 controls were included, at a median age of 19 years (range: 18–25 years of age). They were followed until 2007 and Cox regression models were used to estimate the mortality in the obese relative to the controls. In addition, two reference groups were used: normal weight men (BMI: 18.5–24.9 kg m−2) and the men with the lowest mortality in this cohort (BMI: 22.0–24.9 kg m−2).

Results:

During the 65 years of follow-up, 1191 men died. At all ages from 18 to 80 years, the mortality in the obese was twice that of the controls (hazard ratio (HR): 2.10; 95% confidence interval (CI): 1.84–2.39). The median survival proportion (0.5) was reached about 8 years earlier in the obese than in either of the reference groups. Relative to the normal weight and men with the lowest mortality HRs of 2.14 (95% CI: 1.86–2.45) and 2.38 (95% CI: 2.00–2.85), respectively, were estimated for the obese. Neither year of birth nor education significantly influenced the excess mortality.

Conclusion:

Men entering adult life as obese experience a lifelong doubling of mortality, a finding that strongly supports the continued need to avoid beginning adult life as obese.

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References

  1. Obesity: preventing managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-253.

    Google Scholar 

  2. Wang Y, Lobstein T . Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006; 1: 11–25.

    Article  Google Scholar 

  3. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.

    Article  Google Scholar 

  4. Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010; 363: 2211–2219.

    Article  CAS  Google Scholar 

  5. Engeland A, Bjorge T, Sogaard AJ, Tverdal A . Body mass index in adolescence in relation to total mortality: 32-year follow-up of 227 000 Norwegian boys and girls. Am J Epidemiol 2003; 157: 517–523.

    Article  Google Scholar 

  6. Neovius M, Sundstrom J, Rasmussen F . Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. BMJ 2009; 338: b496.

    Article  Google Scholar 

  7. Waaler HT . Hazard of obesity—the Norwegian experience. Acta Med Scand Suppl 1988; 723: 17–21.

    CAS  PubMed  Google Scholar 

  8. Sonne-Holm S, Sørensen TIA, Christensen U . Risk of early death in extremely overweight young men. Br Med J (Clin Res Ed) 1983; 287: 795–797.

    Article  CAS  Google Scholar 

  9. Christensen U, Sonne-Holm S, Sørensen TIA . Constant median body mass index of Danish young men, 1943–1977. Hum Biol 1981; 53: 403–410.

    CAS  PubMed  Google Scholar 

  10. Sonne-Holm S, Sørensen TIA . Post-war course of the prevalence of extreme overweight among Danish young men. J Chronic Dis 1977; 30: 351–358.

    Article  CAS  Google Scholar 

  11. Sørensen TIA, Sonne-Holm S . Mortality in extremely overweight young men. J Chronic Dis 1977; 30: 359–367.

    Article  Google Scholar 

  12. Teasdale TW, Sørensen TIA, Stunkard AJ . Intelligence and educational level in relation to body mass index of adult males. Hum Biol 1992; 64: 99–106.

    CAS  PubMed  Google Scholar 

  13. Lynch JW, Kaplan GA . Socioeconomic position. In: Berkman LF KI, (ed). Social epidemiology. Oxford University Press: New York, 2000. pp 13–35.

    Google Scholar 

  14. Sonne-Holm S, Sørensen TIA . Prospective study of attainment of social class of severely obese subjects in relation to parental social class, intelligence, and education. Br Med J (Clin Res Ed) 1986; 292: 586–589.

    Article  CAS  Google Scholar 

  15. Pedersen CB, Gotzsche H, Moller JO, Mortensen PB . The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull 2006; 53: 441–449.

    PubMed  Google Scholar 

  16. Rothman K, Greenland S, Lash T . Modern Epidemiology. Third ed. Lippincott, Williams & Wilkins: Philadelphia, PA, 2008.

    Google Scholar 

  17. Hastie TJ, Tibshirani RJ . Generalized Additive Models. Chapman & Hall: New York, NY, 1990.

    Google Scholar 

  18. Doll R, Peto R, Boreham J, Sutherland I . Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004; 328: 1519.

    Article  Google Scholar 

  19. Niedhammer I, Bugel I, Bonenfant S, Goldberg M, Leclerc A . Validity of self-reported weight and height in the French GAZEL cohort. Int J Obes Relat Metab Disord 2000; 24: 1111–1118.

    Article  CAS  Google Scholar 

  20. Sørensen HT, Sabroe S, Gillman M, Rothman KJ, Madsen KM, Fischer P et al. Continued increase in prevalence of obesity in Danish young men. Int J Obes Relat Metab Disord 1997; 21: 712–714.

    Article  Google Scholar 

  21. Flegal KM, Graubard BI, Williamson DF, Gail MH . Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861–1867.

    Article  CAS  Google Scholar 

  22. van Dam RM, Willett WC, Manson JE, Hu FB . The relationship between overweight in adolescence and premature death in women. Ann Intern Med 2006; 145: 91–97.

    Article  Google Scholar 

  23. Bjorge T, Engeland A, Tverdal A, Davey Smith G . Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230 000 Norwegian adolescents. Am J Epidemiol 2008; 168: 30–37.

    Article  Google Scholar 

  24. Hoffmans MD, Kromhout D, de Lezenne CC . The impact of body mass index of 78 612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol 1988; 41: 749–756.

    Article  CAS  Google Scholar 

  25. Jeffreys M, McCarron P, Gunnell D, McEwen J, Smith GD . Body mass index in early and mid-adulthood, and subsequent mortality: a historical cohort study. Int J Obes Relat Metab Disord 2003; 27: 1391–1397.

    Article  CAS  Google Scholar 

  26. McGee DL . Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 2005; 15: 87–97.

    Article  Google Scholar 

  27. Strawbridge WJ, Wallhagen MI, Shema SJ . New NHLBI clinical guidelines for obesity and overweight: will they promote health? Am J Public Health 2000; 90: 340–343.

    Article  CAS  Google Scholar 

  28. Lawlor DA, Hart CL, Hole DJ, Davey Smith G . Reverse causality and confounding and the associations of overweight and obesity with mortality. Obesity 2006; 14: 2294–2304.

    Article  Google Scholar 

  29. Manson JE, Bassuk SS, Hu FB, Stampfer MJ, Colditz GA, Willett WC . Estimating the number of deaths due to obesity: can the divergent findings be reconciled? J Womens Health (Larchmt) 2007; 16: 168–176.

    Article  Google Scholar 

  30. Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (London) 2005; 29: 1011–1029.

    Article  CAS  Google Scholar 

  31. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL . The effect of age on the association between body-mass index and mortality. N Engl J Med 1998; 338: 1–7.

    Article  CAS  Google Scholar 

  32. Heiat A, Vaccarino V, Krumholz HM . An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 2001; 161: 1194–1203.

    Article  CAS  Google Scholar 

  33. Engeland A, Bjorge T, Tverdal A, Sogaard AJ . Obesity in adolescence and adulthood and the risk of adult mortality. Epidemiology 2004; 15: 79–85.

    Article  Google Scholar 

  34. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH . Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922–1935. N Engl J Med 1992; 327: 1350–1355.

    Article  CAS  Google Scholar 

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Acknowledgements

The work was supported by grants from the Cluster for Endocrinology and Metabolism, University of Copenhagen, Denmark. This work is also part of the project ‘Hepatic and adipose tissue and functions in the metabolic syndrome’ (HEPADIP, see http://www.hepadip.org/), which is supported by the European Commission as an Integrated Project under the 6th Framework Programme (Contract LSHM-CT-2005-018734), and part of the research activities in the Danish Obesity Research Centre (DanORC, see http://www.danorc.dk/), supported by the Danish Council for Strategic Research.

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Authors and Affiliations

  1. Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark

    E Zimmermann, C Holst & T I A Sørensen

  2. Institute of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

    E Zimmermann

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  1. E Zimmermann
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  3. T I A Sørensen
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Correspondence to E Zimmermann.

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Competing interests

E Zimmermann and C Holst both declare no conflicts of interest. TIA Sørensen has various industrial collaborations on obesity research as indicated on the website http://www.ipm.hosp.dk/person/tias/Disclosures.html.

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Zimmermann, E., Holst, C. & Sørensen, T. Lifelong doubling of mortality in men entering adult life as obese. Int J Obes 35, 1193–1199 (2011). https://doi.org/10.1038/ijo.2010.274

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